Assessing state level variation in signature authority and cause of death accuracy, 2005-2017.
Assessing state level variation in signature authority and cause of death accuracy, 2005-2017.
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DOI：
10.1016/j.pmedr.2020.101309
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发表时间：
2021-03
影响因子：
2.8
通讯作者：
Landes SD
中科院分区：
文献类型：
--
作者：
Stevens JD;Landes SD
2005年至2017年，美国各州放宽了关于死亡原因签名权的法规。签名权威的州差异导致死亡原因不准确。逻辑回归表明证明人类型影响死亡证明的准确性。死亡证明培训是需要在整个阵列的专业认证。死亡原因签名权威数据库允许对认证错误进行更强大的分析。本研究采用了收敛混合方法设计，以检查是否在死亡证明证明认证类型的变化预测在美国的死亡原因报告的准确性。我们分析了2005-2017年有关死亡原因签名机构的州法规，修正案和政策的内容，以创建死亡原因签名机构（CoDSA）数据库。在将CoDSA数据与2005-2017年国家生命统计系统脑性瘫痪（CP）成年人多原因死亡率文件（N = 29，996）合并后，我们采用逻辑回归模型来确定不同认证机构组犯一种特定类型死亡认证错误的可能性-不准确地报告CP为死亡的根本原因（UCOD）。内容分析提供了死亡原因签名权力显着自由化的证据，有23个州扩大签名权力，包括医生扩展。Logistic回归分析显示，UCOD的准确性的基础上，认证类型的差异。与医学检查人员相比，CP被报告为UCOD的可能性：验尸官高41%（CI 1.12，1.78）;混合系统死亡调查人员高25%（1.05，1.49）;医生高24%（1.08，1.42）;医生扩展员高16%（1.00，1.34）。不准确性限制了旨在改善弱势群体（如CP患者）健康和寿命的公共卫生工作。死亡原因证明人的表现不佳可能表明死亡证明存在系统性问题，应通过对所有具有签名权威的专业团体进行更有力的培训来解决这些问题。
In 2005–2017, US states liberalized statutes on cause of death signature authority. State variation in signature authority contributes to cause of death inaccuracies. Logistic regressions suggest certifier type influences death certificate accuracy. Death certificate training is needed across the array of professional certifiers. Cause of Death Signature Authority database allows for more robust analysis of certification errors. This study utilized a convergent mixed-methods design to examine whether variation in death certificate certifier type predicts the accuracy of cause of death reporting in the US. We analyzed the content of state statutes, amendments, and policies concerning cause of death signature authority in 2005–2017 to create the Cause of Death Signature Authority (CoDSA) database. After merging the CoDSA data with 2005–2017 National Vital Statistics System Multiple Cause of Death Mortality files for adults with cerebral palsy (CP) (N = 29,996), we employed logistic regression models to determine the likelihood that different certifier groups made one particular type of death certification error – inaccurately reporting CP as the underlying cause of death (UCOD). The content analysis provided evidence of significant liberalization of cause of death signature authority, with 23 states expanding signature authority to include physician extenders. Logistic regression analysis revealed differences in UCOD accuracy based on certifier type. Compared to medical examiners, the likelihood of CP being reported as the UCOD, was: 41% higher (CI 1.12, 1.78) for coroners; 25% higher (1.05, 1.49) for mixed-system death investigators; 24% higher (1.08, 1.42) for physicians; and 16% higher (1.00, 1.34) for physician extenders. Inaccuracies limit public health efforts aimed at improving the health and longevity for disadvantaged populations, such as people with CP. Poor performance among cause of death certifiers may indicate systemic problems with death certification that should be addressed with more robust training for all professional groups with signature authority.
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